Pneumonia, eosinophilic acute J18.9

Allen JN 1989

Acute (idiopathic) eosinophilic pneumonia is an etiologically unexplained acute febrile illness associated with severe hypoxemia, bilateral extensive pulmonary infiltrates (predominantly milk glass opacity), and usually absent blood eosinophilia. The disease may be associated with hypereosinophilia syndrome (HES) (40% of HES patients have detectable eosinophilic pulmonary infiltrates).

m:w=3:2

Acute hypersensitivity reaction to an as yet unidentified inhalant allergen is assumed. Smoking is discussed as a triggering factor. Furthermore, various drugs and inhalation drug use are considered.

Children and adults (5th decade of life)

Acute febrile illness of < 5 days' duration with cough, myalgias, pleuritic chest pain, and rapidly progressive respiratory failure.

The association of eosinophilic pneumonia with "eosinophilic anular erythema" has been described which should be interpreted as erythema anulare centrifugum (Yanagihara S et al. 2021).

Diagnosis is confirmed by BAL; detection of >25% eosinophilic granulocytes. Parasitic, mycotic (e.g. aspergillosis) or other infections associated with eosinophilia are excluded.

Rapid and complete therapeutic response to high-dose glucocorticoids. No recurrence after discontinuation of steroidal medication.

Drugs associated with eosinophilic penumony (var. according to C. Kroegel 2000)

• Ampicillin
• Allopurinol
• Carbamazepine
• Clofibrate
• Cocaine (inhaled)
• Daptomycin
• Diclofenac
• Febuten
• Phenytoin
• Barbiturates
• Dapson
• GM-CSF
• Ibuprofen
• interleukin-2
• iodinated contrast media
• L-Tryptophan
• Methotrexate
• Minocycline
• Naproxen
• Nitrofurantoin
• Pentamidine (inhaled)
• Strontium ranelate (osteoporosis agent).
• Sulfonamides
• Tamoxifen

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